Neurologist

joined 9 months ago
 

Summary:

Selective outcome reporting can result in overestimation of treatment effects, research waste, and reduced openness and transparency. 

This review aimed to examine selective outcome reporting in trials of behavioural health interventions and determine potential outcome reporting bias. 

A review of nine health psychology and behavioural medicine journals was conducted to identify randomised controlled trials of behavioural health interventions published since 2019. 

Discrepancies in outcome reporting were observed in 90% of the 29 trials with corresponding registrations/protocols. 

Discrepancies included 72% of trials omitting prespecified outcomes; 55% of trials introduced new outcomes. 

Thirty-eight percent of trials omitted prespecified and introduced new outcomes. Three trials (10%) downgraded primary outcomes in registrations/protocols to secondary outcomes in final reports; downgraded outcomes were not statistically significant in two trials. 

Five trials (17%) upgraded secondary outcomes to primary outcomes; upgraded outcomes were statistically significant in all trials. 

In final reports, three trials (7%) omitted outcomes from the methods section; three trials (7%) introduced new outcomes in results that were not in the methods. 

These findings indicate that selective outcome reporting is a problem in behavioural health intervention trials. 

Journal- and trialist-level approaches are needed to minimise selective outcome reporting in health psychology and behavioural medicine.

My Comment: We need better ethics and more rigorous methodology.

[–] [email protected] 6 points 3 months ago* (last edited 3 months ago)

Damn I can’t find the original gif from the movie. Here’s a low quality edit I could find.

[–] [email protected] 11 points 4 months ago

No it’s not.

We usually have guidelines and protocols to follow which minimise the chance of harm and standardise care. Here we’re left with nothing, unsure what we’re allowed to do or not, unsure what we should do. There have already been multiple reports of mismanagement of pre-natal care resulting in deaths because of this.

 
[–] [email protected] 1 points 4 months ago

Crispr is the exception:

  1. it’s massively expensive
  2. it can cure multiple illnesses and perform loads of other functions

Most proposals for cures are a fairly simple (and cheap) therapeutic target that will only work for one condition or even just a subset of cases within that condition.

[–] [email protected] 16 points 4 months ago (2 children)

That’s the lenient interpretation I’d hope.

But we’re not an alternative medicine group or anything. If you look into their shareholder meetings the public info seems to be that they judge whether investments are worth it by potential return on investment, and well a lifelong treatment is always going to be more profitable for them than a cure.

[–] [email protected] 33 points 4 months ago (6 children)

Completely true. But there would be fewer of them.

It’s crazy that when my research team comes up with a therapeutic target we believe might lead to curing a disease, we get crickets from drug companies. But when we present therapeutic targets for long term treatment, we get lots of interest.

[–] [email protected] 7 points 4 months ago

Sounds like my colleagues. But since medicine is a hierarchical culture that values conformity over critical thought, that type of behaviour tends to actually work in favour of the person.

[–] [email protected] 25 points 4 months ago* (last edited 4 months ago) (9 children)

Although it’s true that nurses can have some fucked up beliefs, don’t underestimate doctors. Some of my colleagues are ableist, misogynistic, bigoted, power hungry, with a superiority complex. I think these are the kind of Gps and specialists making r/medicine so awful.

[–] [email protected] 52 points 4 months ago (15 children)

That aside, as a medical professional, I have to say r/medicine is such a cesspool of a subreddit, and I don’t say this lightly.

They regularly ridicule patients and specific conditions, harbour prejudiced views towards poor people and people from minority groups, and generally push pseudoscientific nonsense.

It’s a really disheartening subreddit to visit when you’ve got your patient’s best interests at heart.

Apart from that, I do agree with their view on UnitedHealth’s CEO.

[–] [email protected] 1 points 6 months ago (1 children)

if youve got to any, could you tell me what you think? It’s always useful to know what I should recommend to my patients to show their friends and family.

[–] [email protected] 2 points 6 months ago* (last edited 6 months ago) (3 children)

This channel has a bunch of short (5 mins long videos) about ME to educate people.

There’s also a slightly outdated (but still worth the watch) oscar nominated documentary about it, which has been made free and put on youtube recently It’s Unrest by Jennifer Brea

One of my patients also runs this excellent website with a bunch of resources about the disease.

[–] [email protected] 5 points 6 months ago* (last edited 6 months ago) (1 children)

I’m sorry I really shouldn’t be giving medical advice. It’s been a long time since I studied neurology. I’ve spent the past decade only on post viral diseases like ME.

But please please find yourself a doctor that listens and cares if that is possible. Because it clearly sounds like you need tests and you need a doc thats available for you. Maybe join some local MS support groups and ask if anyone has docs that do a really good job and try from there.

I’ll tell you this as a doctor. I would stay the hell away from some of my colleagues. Not every doctor is anywhere near good at their jobs. Some don’t care, some barely passed and don’t want to learn anything new, some like to always assume their patients have psychological problems. Find yourself a good doctor who is proactive and cares, and everything will be so much easier. Sending you good luck.

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submitted 6 months ago* (last edited 6 months ago) by [email protected] to c/[email protected]
 

ELI12 TLDR: Decent accuracy was found ~80% when using these to differentiate between people with Long COVID versus people who had recovered. People with Long COVID tend to have high Artemin which is linked to nerve cell communication problems and the elevated levels found may provide a clue into the cognitive problems many of these patients have. High Galectin-9 levels (which were also found here) are often associated with immune issues such as overactivation, which seems to fit well with all the immune abnormalities we see in these patients.

Abstract: This study aimed to assess plasma galectin-9 (Gal-9) and artemin (ARTN) concentrations as potential biomarkers to differentiate individuals with Long COVID (LC) patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) from SARS-CoV-2 recovered (R) and healthy controls (HCs). Receiver operating characteristic (ROC) curve analysis determined a cut-off value of plasma Gal-9 and ARTN to differentiate LC patients from the R group and HCs in two independent cohorts. Positive correlations were observed between elevated plasma Gal-9 levels and inflammatory markers (e.g. SAA and IP-10), as well as sCD14 and I-FABP in LC patients. Gal-9 also exhibited a positive correlation with cognitive failure scores, suggesting its potential role in cognitive impairment in LC patients with ME/CFS. This study highlights plasma Gal-9 and/or ARTN as sensitive screening biomarkers for discriminating LC patients from controls. Notably, the elevation of LPS-binding protein in LC patients, as has been observed in HIV infected individuals, suggests microbial translocation. However, despite elevated Gal-9, we found a significant decline in ARTN levels in the plasma of people living with HIV (PLWH). Our study provides a novel and important role for Gal-9/ARTN in LC pathogenesis.

 

Nearly 200 health professionals have written to the health secretary saying that patients with the illness are being left to ‘languish behind closed doors’

The Times (UK)

Doctors have said that NHS patients with myalgic encephalomyelitis (ME) risk starving to death because of unsafe and “unconscionable” standards of care. 

The letter calls for the government to take action to address the “serious patient safety concerns” for patients with ME, an illness which affects about 250,000 people in the UK.

More than 200 health professionals including GPs, hospital consultants and nurses have written to Wes Streeting, the health secretary, saying that patients with the illness are being left to “languish behind closed doors” because specialist NHS services to provide safe care “do not exist”.

ME, also known as chronic fatigue syndrome, is a complex neurological disorder that leads to symptoms including extreme exhaustion. Severe cases can be fatal, with patients bedridden and unable to eat or drink, but these patients currently “fall through the cracks” as there is no specialist NHS care provision. 

A letter signed by 202 doctors and NHS staff calls on ministers to convene an ME clinical task force providing “emergency specialist guidance in cases where patients are hospitalised”, as well as to commit to holding NHS trusts “accountable” for care.

They write: “There is little access to truly specialist ME care or treatment within the NHS and paradoxically, the sicker a patient is, the less care they receive.

“Even if doctors and healthcare professionals are knowledgeable and willing to treat patients, the infrastructure to provide safe and appropriate care does not exist.”

[…]

 

Background

A considerable number of patients who contracted SARS-CoV-2 are affected by persistent multi-systemic symptoms, referred to as Post-COVID Condition (PCC). Post-exertional malaise (PEM) has been recognized as one of the most frequent manifestations of PCC and is a diagnostic criterion of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Yet, its underlying pathomechanisms remain poorly elucidated.

Results

Upon physical activity, affected patients exhibit a reduced systemic oxygen extraction and oxidative phosphorylation capacity. Accumulating evidence suggests that these are mediated by dysfunctions in mitochondrial capacities and microcirculation that are maintained by latent immune activation, conjointly impairing peripheral bioenergetics. Aggravating deficits in tissue perfusion and oxygen utilization during activities cause exertional intolerance that are frequently accompanied by tachycardia, dyspnea, early cessation of activity and elicit downstream metabolic effects. The accumulation of molecules such as lactate, reactive oxygen species or prostaglandins might trigger local and systemic immune activation. Subsequent intensification of bioenergetic inflexibilities, muscular ionic disturbances and modulation of central nervous system functions can lead to an exacerbation of existing pathologies and symptoms

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